Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

353/440 (page 335)

by sewiug it to the abdominal walls (183). Favoui'ablo results however from this proceeding, based as it is on incorrect anatomical and pathological ideas, is not to be expected. If an attempt were made (as by Hahn) to make an incision in the lumbar region and get the kidney to heal in it, this proceeding would displace the kidney, whose normal situation is higher and more lateral than the lumbar incision. But if an attempt is made to sew the kidney into its normal situation, it would be necessary to resect one or two ribs, or insert sutures at random into the last intercostal space through the muscles and the kidney. In either case one would expect to open the pleural cavity and to puncture important vessels and nerves. But even after the sewina* has been safely accomplished, a cure of the moveable kidney is not to be expected, for we have not two serous surfaces, capable of mutual adhesion, to deal with, and the causes of the mobility of the kidney are of course not removed by sewiug. All these experiments, unpromising and dangerous as they would seem a ■priori, can however be abandoned, as it is not necessary, in order to remove the discomforts caused by moveable kidney, to fix it in its normal situation; but just as in the case of retroflexion of the uterus it is generally suflicient to keep it as immoveable as possible. With this view we must act indirectly on the kidney by fixation of the abdominal walls and viscera, since it is impossible to act directly upon it. This is best accompHshed by a comfortable and firm binder encircling the whole abdomen. If the kidneys are only prevented from constant movements down- wards and inwards, and from rotation on their axes, the discomforts caused by dragging of the nerves and vessels as well as by pressure, cease. It is of course difiicult to produce general immobility of the abdominal contents and walls by a binder, because the size and shape of the abdomen vary not only in different individuals, but even in the same person, during breathing, and with different postures, movements, &c. Even binders accurately made to the measures of the abdomen do not therefore fulfil the desired end, for they ride up as the patient walks, and leave the lower half of the abdomen free for the descent of the abdominal contents, or they exert